Registration for Courses CONTACT INFORMATION Name * Email * Phone * COURSE QUESTIONS Date of Course * Name of Course * EMERGENCY AND HEALTH QUESTIONS Emergency Contact Name * Emergency Contact Relationship * Emergency Contact Phone * Allergies: (please be specific - medications, insects, plants, gluten, etc...) Are you at Risk of anaphylactic shock? * Yes No If yes, where do you keep the epi-pen? Do you have any health issue or disabilities that are relevant to the activities of this program (which may include field work that involves some hiking)? COURSE EXPERIENCE What is your previous experience studying or working with: (no previous experience is required or expected) Plants Healing Herbal Medicine OTHER QUESTIONS/COMMENTS Why have you chosen this course? What are you hoping to learn? What would you like for me, as the instructor, to know about you to help make this a quality experience for you? Other Comments/Questions Submit
